[Minimal invasive surgery-transforaminal lumbar interbody fusion combined with expanded pedicle screw through Mast Quadrant channel for the treatment of senile pyogenic discitis and vertebral osteomyelitis]

Abstract

Objective: To investigate the feasibility and clinical efficacy of minimal invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) combined with expanded pedicle screw (EPS) in the treatment of elderly patients with pyogenic discitis and vertebral osteomyelitis (PDVO).

Methods: The clinical data of 11 elderly patients with pyogenic discitis and vertebral osteomyelitis treated from January 2016 to June 2017 were retrospectively analyzed, including 7 males and 4 females, aged from 59 to 79 years old with an average of (68.09±5.34) years. The MIS-TLIF technique was used assisted by the Quadrant channel under general anesthesia for the debridement and bone fusion of these 11 elderly patients. The posterior fixation was performed with EPS. The operation time, intraoperative blood loss, intraoperative blood transfusion, and postoperative time of out of bed, postoperative complications and erythrocyte sedimentation rate(ESR)were recorded. Visual analogue scale (VAS) was used to evaluate the clinical effects and the imaging data were used to observe lumbar fusion.

Results: All the operations were successfully performed, the debridement was thorough, bone fusion was adequate, and no complications such as dural sac and nerve root injury were found. The operation time and intraoperative blood loss was(179.55±59.05) min and (174.55±49.22)ml, respectively. Concentrated red blood cells of (109.09±97.00) ml and plasma of (72.73±100.91) ml were given during operation. The time of out of bed was(1.19±0.83) d. All the incisions obtained healing at the first stage. The average follow-up time was(19.27±11.63) months. VAS scoring at 1 week and 6 months after surgery was 3.73±1.01 and 2.18±0.40;ESR at 6 weeks after surgery was(19.27±2.61) mm/h(decreased by more than 50%), at 6 months after surgery was (9.55±1.01) mm/h, both within normal range. During the follow-up period, all patients reached the clinical cure standard, and the bone fusion time was(5.54±1.51) months.

Conclusions: MIS-TLIF combined with EPS through Quadrant channel in the treatment of elderly patients with PDVO has achieved minimally invasive surgery. The feasibility of this method also has been verified and satisfactory clinical results have been achieved. It is a safe and reliable treatment for elderly patients with spinal suppurative osteomyelitis.

Keywords: Elderly; Expandable pedicle screw; Pyogenic discitis and vertebral osteomyelitis; Quadrant channel; Spinal minimally invasive surgery.